WASHINGTON, DCA gap exists between policy makers
expectations that current commercial electronic medical records (EMRs) can improve
coordination of patient care and clinicians real-world experiences with EMRs,
according to a study by the Center for Studying Health System Change (HSC) published
online in The Journal of General Internal Medicine.

Current commercial ambulatory care EMRs facilitate care coordination within
a practice by making information available at the point of care but are less
helpful for exchanging information across physician practices and care settings,
according to the study supported by the Commonwealth Fund.

Clinicians identified many areas where both the design of EMRs might be altered,
and office care processes modified, to improve EMRs support for tasks involved
in coordinating patient care, according to the study.

Additionally, while current commercial EMR design is driven by clinical documentation
needs, there is a heavy emphasis on documentation to support billing rather
than patient and provider needs related to clinical management, the study found.
And, current fee-for-service reimbursement encourages EMR use for documentation
of billable events&151;office visits, proceduresand not for care coordination,
which is not a billable activity.

The Journal of General Internal Medicine article, titled "Are Electronic
Medical Records Helpful for Care Coordination? Experiences of Physician Practices,"
is based on a total of 60 interviews52 physicians and other staff at 26 small
and medium-sized physician practices with commercial ambulatory EMRs in place
for at least two years; chief medical officers at four EMR vendors; and four
national thought leaders active in health information technology implementation.

"This work emphasizes that improving care coordination will not happen
with technology alone," said Commonwealth Fund Vice President Anne-Marie
Audet, M.D. "What is needed is a redesign of care processes and work flow;
clinicians will also need to adopt new ways of working and communicating within
practices and across organizations."

Other key study findings include:

EMRs may have unintended consequences for care coordination, such as
creating information overload that complicates providers efforts to discern
key clinical information. And managing information overflow from EMRs is a challenge
for clinicians.

Clinicians believe current EMRs have limited ability to capture dynamic
planning and the medical decision-making process in a way that supports future
coordination needs-present EMRs focus on linear (moment-in-time) documentation
while care coordination is dynamic and ongoing.

Maximizing the potential of an EMR for coordination involves ongoing
evolution of clinical care processes as well as clinician input on EMR design
modifications and standards for data exchange to support those processes.

Modifying reimbursement to encourage coordination of care by clinicians
will likely drive clinicians to demand better EMR functioning to support coordination.

Simply creating incentives to adopt EMRs as they currently exist, given
the confines of the current payment system, may result in EMRs being designed
for billing purposes primarily rather than for clinical relevance to patients
and care coordination.

The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded in part by the
Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.

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The Commonwealth Fund is a private foundation working to promote a high
performing health care system that achieves better access, improved quality,
and greater efficiency, particularly for societys most vulnerable. The Fund
carries out this mandate by supporting independent research on health care issues
and making grants to improve health care practice and policy.